Saturday, October 10, 2015

They approach with the fervor of a football fan attacking a keg at a tailgate party. "Which method of meditation do you use?"

I admit that I don't meditate, and they are incredulous. It's as if I've just announced that the Earth is flat. "How could you not meditate?!"

I have nothing against it. I just happen to find it dreadfully boring.

"But Steve Jobs meditated!"

Yeah, and he also did L.S.D. — do you want me to try that, too?

"L.S.D. is dangerous. Science shows that meditation is good for you. It will change your life."

Will it?

Meditation is exploding in popularity. There are classes to learn meditation in all its flavors: mindfulness-based stress reduction, transcendental meditation, Zen and more. There are meditation events with power-networking opportunities built in. Drop by the Path in New York, and you can mingle with people in tech, film, fashion and the arts. Pay a visit to the World Economic Forum in Davos, Switzerland, and you get to do an early morning guided meditation with global leaders. As Arianna Huffington has said, C.E.O.s are increasingly coming out of the closet — as meditators.
Before we're all swept into this fad, we ought to ask why meditation is useful. So I polled a group of meditation researchers, teachers and practitioners on why they recommend it. I liked their answers, but none of them were unique to meditation. Every benefit of the practice can be gained through other activities.

This is the conclusion from an analysis of 47 trials of meditation programs, published last year in JAMA Internal Medicine: "We found no evidence that meditation programs were better than any active treatment (i.e., drugs, exercise and other behavioral therapies)."

The primary reason people meditate, the experts tell me, is that it may reduce stress. Fine. But so does quality sleep and exercise. And you can reduce stress simply by changing the way you think about it. When you're feeling anxious, it's a signal that you care about the outcome of an upcoming event — and it can motivate you to prepare.

Friday, October 9, 2015

HARRISBURG, Pa. — The doctors-in-training removed their shoes and padded into Glorian Watson's tidy first-floor apartment in socks and bare feet. They pulled up chairs at her dining room table, plopped down on her love seat and caught up with the cheerful 52-year-old whose body often rebels against her, with digestive issues so severe that she can find herself hospitalized for days or weeks.

These doctors-to-be don't know much about her illness, Crohn's disease. They can't prescribe her medications, order lab tests or admit her to a hospital. Instead, they're here to learn something that most medical schools never teach but that matters as much: What's in her fridge? Does she have a ride to an upcoming appointment? Can she afford her drugs and gluten-free diet?

"We learn a lot about barriers to health care that physicians don't normally think about," said Christopher Davis, a second-year medical student at Penn State College of Medicine.

U.S. health care is in a revolution that is starting to shake up one of the most conservative parts of medicine: its antiquated model for training doctors.

Once paid a la carte for the procedures and services they perform, physicians are beginning to be reimbursed for keeping their patients healthy. Doctors trained in the science of medicine, the diagnosis and treatment of the sick person in front of them, are increasingly responsible for helping to keep their patients out of the hospital.

Thursday, October 8, 2015

INDEPENDENCE, Kan. — The rooms in the intensive care unit are filled with folded-up walkers and moving boxes. In the lobby, plaques and portraits have been taken off the wall. By this weekend, the last patients will be discharged and Mercy Hospital Independence will close, joining dozens of rural hospitals around the country that have not been able to withstand the financial and demographic challenges buffeting them.

The hospital and its outpatient clinics, owned by the Mercy health care system in St. Louis, was where people in this city of 9,000 turned for everything from sore throats to emergency treatment after a car crash. Now, many say they are worried about what losing Mercy will mean not just for their own health, but for their community's future.

Mercy will be the 58th rural hospital to close in the United States since 2010, according to one research program, and many more could soon join the list because of declining reimbursements, growing regulatory burdens and shrinking rural populations that result in an older, sicker pool of patients. The closings have accelerated over the last few years and have hit more midsize hospitals like Mercy, which was licensed for 75 beds, than smaller "critical access" hospitals, which are reimbursed at a higher rate by Medicare.

Whether in Yadkinville, N.C.; Douglas, Ariz.; or Fulton, Ky., all of whose hospitals were also shuttered this year, these institutions are often mainstays of small communities, providing not just close-to-home care but also jobs and economic stability.

Wednesday, October 7, 2015

If you're among of the millions of Americans who dutifully carve out 30 minutes a day for the moderate-intensity exercise recommended by experts some disappointing news.

A new analysis published Monday in the journal Circulation finds that that amount of activity may not be good enough.

For the paper, researchers reviewed 12 studies involving 370,460 men and women with varying levels of physical activity. Over a mean follow-up time of 15 years, this group experienced 20,203 heart failure events. Each of the participants self-reported their daily activities, allowing the team to estimate the amount of exercise they were doing.

They found that those following the 30-minutes-a-day guidelines issued by the American Heart Association had "modest reductions" in heart failure risk compared to those who did not work out at all.

But those who exercised twice and four times as much had "a substantial risk reduction" of 20 percent and 35 percent, respectively.

The findings challenge the notion of a 30-minutes-a-day magic number for exercise. Instead, research found that physical activity and heart failure may be what they called "dose dependent," meaning that higher levels of physical activity appeared to be linked to a lower risk of heart failure. That association appeared to hold across age groups, gender and race.

Jarett D. Berry, senior author of the study and an associate professor at University of Texas Southwestern Medical School, said the study shows that physicians and health policymakers should consider making stronger recommendations for greater amounts of physical activity to prevent heart failure.

Before he got sick, Whitney Dafoe was an award-winning photographer and a world traveler. He'd helped build a nunnery in India, ridden a motorcycle in the Himalayas and visited all 50 American states.

He also worked on Barack Obama's 2008 presidential campaign, and although he was already ill by January 2009, pushed himself to travel to Washington from his California home to photograph the inauguration.

But now, at 31, Whitney lies in bed in a darkened room in his parents' home, unable to talk, walk or eat. He is fed intravenously and is barely able to tolerate light, sounds or being touched. His parents and the medical personnel who see him wear plain clothing when they enter his room because bright colors, shapes or any kind of print make him feel even worse, as does any movement that he's not expecting.

"It's hard to explain how fragile he is," says his mother, Janet Dafoe.

This isn't the picture that people imagine when they hear "chronic fatigue syndrome," which is often viewed by the public and the health-care community as a trivial or primarily psychological complaint.

In a February report, the Institute of Medicine gave the illness a new name — systemic exertion intolerance disease. Many patients have long criticized the name "chronic fatigue syndrome" for not reflecting the seriousness of the illness. The new name, some say, is not much of an improvement. Some patients call it by an older name, "myalgic encephalomyelitis." Most official documents refer to it with a compromise term, "myalgic encephalomyelitis/chronic fatigue syndrome," or ME/CFS.

The IOM report notes that doctors often lack understanding of the condition and are often skeptical that it is a true medical condition, believing instead that it's partially or wholly psychological.

Britain may not be the best place to live, but it is the best place to die.

The Economist Intelligence Unit (EIU) ranked the country first in its latest quality-of-death index, which uses 20 quantitative and qualitative indicators to measure the effectiveness of end-of-life care in 80 countries. The measures include the the quality of palliative care, affordability, the health care environment, and community engagement.

How we die is becoming a critical topic as populations live longer, often with multiple diseases requiring complex (and costly) management. Developing countries in particular grapple with how to deliver basic pain relief to the dying. Some have seen notable improvements in recent years: Uganda has dramatically increased the availability of morphine through a public-private partnership between the health ministry and Hospice Africa, a British charity.

Not surprisingly, rich countries generally did better than poor ones in the rankings. But there are noteworthy variations: the US came in ninth place with a score of 80.8 (out of 100), far below the 93.9 score achieved by Britain, where complaining about health care is as popular as grumbling about the weather.

U.S. dietary guidelines have long recommended that people steer clear of whole milk, and for decades, Americans have obeyed. Whole milk sales shrunk. It was banned from school lunch programs. Purchases of low-fat dairy climbed.

"Replace whole milk and full-fat milk products with fat-free or low-fat choices," says the the Dietary Guidelines for Americans, the federal government's influential advice book, citing the role of dairy fat in heart disease.

Whether this massive shift in eating habits has made anyone healthier is an open question among scientists, however. In fact, research published in recent years indicates that the opposite might be true: millions might have been better off had they stuck with whole milk.

Scientists who tallied diet and health records for several thousand patients over ten years found, for example, that contrary to the government advice, people who consumed more milk fat had lower incidence of heart disease.

By warning people against full-fat dairy foods, the U.S. is "losing a huge opportunity for the prevention of disease," said Marcia Otto, an assistant professor of epidemiology at the University of Texas, and the lead author of large studies published in 2012 and 2013, which were funded by government and academic institutions, not the industry. "What we have learned over the last decade is that certain foods that are high in fat seem to be beneficial."

Tuesday, October 6, 2015

Rachel Brill and Mary McCarthy are seniors and longtime roommates at St. Mary's College of Maryland. This year, they share their four-bedroom campus apartment with two other female students. Also, Theo and Carl.

Theo, easygoing and unflappable, is a tawny, 103-pound, longhaired German shepherd. Carl, an energetic charm magnet, is a jet-black, 1.5-pound Netherland Dwarf rabbit.

House rules: Carl must reside in a pen under Ms. McCarthy's raised bed; Theo snoozes in a crate in Ms. Brill's bedroom. Carl cannot be let loose in the living room, where Theo likes to hang out. "We're still very careful because we don't want there to be an issue with Theo and Carl," Ms. McCarthy said. "We're both very anxious people."

And that is exactly why Theo and Carl have permission to live in campus housing.

Like many schools across the country, St. Mary's, a small, public liberal arts college, is figuring out how to field increasing requests for animals by students with diagnosed mental health problems. Last fall it began allowing "comfort animals" for students like Ms. Brill, Theo's owner, who has anxiety and depression, and Ms. McCarthy, Carl's owner, who gets panic attacks.

Anxiety, followed closely by depression, has become a growing diagnosis among college students in the last few years. The calming effect of some domesticated animals has become so widely accepted that many schools bring in trained therapy dogs to play with stressed students during exam periods.
But as students with psychiatric diagnoses are asking to reside on campus with their own animals, schools with no-pet housing policies are scrambling to address a surfeit of new problems. How can administrators discern a troubled adolescent's legitimate request from that of a homesick student who would really, really like a kitten? If a student with a psychological disability has the right to live with an animal, how should schools protect other students whose allergies or phobias may be triggered by that animal?

The topic is being hotly debated by college housing and disability officials in the wake of discrimination lawsuits filed by students who were denied so-called emotional support animals. Last month, on the eve of a trial in a case closely watched by administrators, the University of Nebraska at Kearney settled with the Justice Department, agreeing to pay $140,000 to two students who had been denied support animals, and spelling out protocols for future requests. Recently, a federal judge refused to dismiss a similar case against Kent State University.

"The disabilities services people are all looking at what they need to do to make this work," said Jane Jarrow, an educational disabilities consultant who is teaching "Who Let the Dogs In?" — an online course about emotional support animals — for the fourth time this year. "We're way past pretending it's not going to happen."

In the years before support animal lawsuits, universities found it relatively easy to say no to requests
The overwhelming majority of support animal requests are for dogs and cats. But schools have had requests for lizards, tarantulas, potbellied pigs, ferrets, rats, guinea pigs and sugar gliders — nocturnal, flying, six-ounce Australian marsupials.

Three scientists who developed therapies against parasitic infections have won this year's Nobel Prize in Physiology or Medicine.

The winners are: William C. Campbell, a microbiologist at Drew University in Madison, New Jersey; Satoshi Ōmura, a microbiologist at Kitasato University in Japan; and Youyou Tu, a pharmacologist at the China Academy of Chinese Medical Sciences in Beijing.

In the 1970s, Campbell and Ōmura discovered a class of compounds, called avermectins, that kill parasitic roundworms that cause infections such as river blindness and lymphatic filariasis. The most potent of these was released onto the market in 1981 as the drug ivermectin.

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Tu, who won a Lasker prize in 2011, developed the antimalarial drug artemisinin in the late 1960s and 1970s. She is the first China-based scientist to win a science Nobel. "This certainly is fantastic news for China. We expect more to come in the future," says Wei Yang, president of the nation's main research-funding agency, the National Natural Science Foundation of China.

Malaria breakthrough

In the 1960s, the main treatments for malaria were chloroquine and quinine, but they were proving increasingly ineffective. So in 1967, China established a national project against malaria to discover new therapies. Tu and her team screened more than 2,000 Chinese herbal remedies to search for drugs with antimalarial activity. An extract from the wormwood plant Artemisia annua proved especially effective and by 1972, the researchers had isolated chemically pure artemisinin.

That Tu won the Nobel prize is "great news", says Yi Rao, a neuroscientist at Peking University in Beijing who has researched the discovery of artemisinin. "I'm very happy about this. She totally deserves it."

But there has been some controversy over credit for the discovery, Rao points out, so Tu has never won a major award in China. She has not been elected to either of China's major academies — neither the Chinese Academy of Sciences nor the Chinese Academy of Engineering.

"Though other people were involved, Tu was clearly the undisputed leader," says Rao. "But she's never been given fair recognition within China."

Lan Xue, an innovation-studies specialist at Tsinghua University in Beijing, says that he has been inundated with messages about the prize. "People will be celebrating, but I hope they also take a sober look, because there are lots of things to learn from this award," he says.

Young scientists in China today are told to go overseas to do good research and to churn out publications in internationally recognized journals, Xue notes. Yet Tu never worked outside China, and did not rack up major publications. "Tu doesn't fit into any of the trends today, and yet she gets the Nobel because of the originality of her work. It couldn't have been a better choice in terms of the lessons it offers Chinese scientists," he says.

They will be out there throughout the baseball playoffs, on the pitching mound each day, though they will not be easy to see. They range from seven to nine centimeters in length. Some are thick, others thin and faded. They tell the story of the modern pitcher.

About a quarter of active major league pitchers have had elbow surgery to repair a damaged ulnar collateral ligament. Some have had it multiple times. The operation, known as Tommy John surgery, after the first pitcher to undergo it, leaves players with a crescent-shaped scar inside the elbow.

The scar is the physical mark of both the epidemic and an individual player's history. Each scar, like rings on a stump, reveals the past: which doctor performed the operation, how long ago the player had it and whether he had it more than once.

"The funny thing is," said David Altchek, the Mets' doctor, "nobody ever sees it except the batter."
The scar, of course, depends partly on the surgeon. Even two members of the same pitching rotation, of about the same age, can have very different scars. The Mets' two aces, Matt Harvey and Jacob deGrom, were operated on by different surgeons who used different techniques.